The Linear-Quadratic Model Is an Appropriate Methodology for Determining Isoeffective Doses at Large Doses Per Fraction

The tool most commonly used for quantitative predictions of dose/fractionation dependencies in radiotherapy is the mechanistically based linear-quadratic (LQ) model. The LQ formalism is now almost universally used for calculating radiotherapeutic isoeffect doses for different fractionation/protraction schemes. In summary, the LQ model has the following useful properties for predicting isoeffect doses: (1) it is a mechanistic, biologically based model; (2) it has sufficiently few parameters to be practical; (3) most other mechanistic models of cell killing predict the same fractionation dependencies as does the LQ model; (4) it has well-documented predictive properties for fractionation/dose-rate effects in the laboratory; and (5) it is reasonably well validated, experimentally and theoretically, up to about 10 Gy/fraction and would be reasonable for use up to about 18 Gy per fraction. To date, there is no evidence of problems when the LQ model has been applied in the clinic.